Nebulizers are recognized as potential nosocomial infection agents. We studied microbial contamination in inhaled solutions in ultrasonic nebulizers used in the clinical setting. High contamination (≥ 10³ CFU/ml) was detected in 14% of samples. Damage to medication cups by ultrasonics and backward saliva flow from a corrugated tube were considered possible causes of microbial contamination. High contamination dropped to 6% in samples with new medication cups and the use of back-flow adapters.

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Aerosol-related equipment include specific otolaryngology examination and treatment devices that are widely used in otolaryngology outpatient clinics. Such equipment is used to facilitate diagnoses and to treat different ear, nose, mouth, pharynx and larynx disorders. Aerosol-related equipment include ENT examination and nebulizer units. ENT examination units can be used to spray medicated liquids or to suction secretions or blood from inside the ear, nose, oral cavity or pharynx; thus, the chance that an ENT examination unit may come in contact with a patient's skin or mucus membranes is quite large. Nebulizer units also come into direct contact with a patient's nose or oral cavity when used. At our hospital, the tips of the spray unit are disinfected after every use by wiping them with alcohol-soaked cotton pieces. Suction tips are changed after every use and are replaced with a disinfected tip. Our hospital uses an ultrasonic nebulizer. The present study investigated the presence and amount of bacteria and fungi on aerosol-related equipment including the tips of spray units, the liquid inside the units, the suction tips, and components of the nebulizer unit.

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We studied the effects of mouth wash-mouth rinsing and gargling- on removing drug residues from the mouth after steroid nebulization. The concentration of fluticazone propionate in mouthwash after drug inhalation was measured by HPLC. We used sodium hyaluronate solution and water and the mouth was wet or dry. Sodium hyaluronate solution removed drugs from the mouth better than water and removal was greater under wet than dry conditions. These results indicate that sodium hyaluronate solution is useful for removing steroid nebulization residue from the mouth. Conditions in the mouth should also be noted before gargling in giving guidance to patients.

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We compared improvement in pulmonary function (PF), subjective and objective symptoms (SOS), and distal small airway inflammatory, evalution (DSA IE) in induced sputum by 10% hypertonic saline solution by Budesonide-Tubhaler (BUD-TH) in stable-controlled bronchial asthmatic (BA) patients (Pt) (n = 50, male : female = 21 : 29, 48.2 ± 8.5) by pre oxytropium bromide (O) (+) - inhalation therapy (IT) (group A, n = 25) and pre O (-) -IT (group B, n = 25). After randomizedly selection, BAPt inhaled BUD-TH (446, μ g/d. [200-800μg/d]) after 30min of 0 (+) of O (-) IT (n = 25) after pre I pre OIT (+) (0.2mg/time : mean 0.36mg/d. [0.2-0.8mg/d.]) or pre OIT. After 6m, O IT were reversed in each group. The same study was also done for 6m. Demographical characteristics showed no change between groups. PF such as V₅₀, and V₂₅, SOS such as BA score, and DSA IE such as eotaxin and RANTAS improved more significantly in group A than in group B.
These results suggest that pre-OIT should be considered for effective use of dry powder inhaled corticosteroids that could improve these parameters, as discussed in this paper.

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Transepithelial permeation of nanometer-size particles was investigated by cultured sheets of normal bronchial human and rabbit epithelium. The cultured sheets of normal bronchial epithelial cells were obtained in several subculture steps, and the cultured epithelium was evaluated by a transmission electron microscopy for the morphology of the cell sheets and by a transepithelial electrical resistance method to check their thickness.
In the cell culture MSAGM was used to grow normal bronchial epithelial cells plated at a density of approximately 10⁶ cells/cm² on fibronectin-coated filters. The cells were cultured for 10 days to obtain as a 3-dimensional culture sheets whose morphology most closely approximated the morphology of normal human bronchial epithelium in vivo by the air-contact method. Lanthanum hydroxide (LH) particles 2 nm in diameter were used as the nanometer-size particles to test the transepithelial permeability.
The results of the TEM analysis confirmed transepithelial permeation of the nanometer-size particles in the intercellular spaces and the goblet cells of the cultured epithelum, and a significantly larger amount of LH in the intercellular spaces. Since the LH was observed at the tight junctions of the bronchial epithelum, the effective pathway for transepithelial permeation of the nanometer-size particles was in the intercellular spaces.

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We studied the effectiveness of a mist sauna generating 48°C mist in the bathroom at home on nasal congestion due to nasal allergy. We compared the effectiveness of sauna for 10 minutes to that of normal bathing at 40°C in alleviating nasal congestion as determined using the visual analog scale (VAS) and acoustic rhinometry (AR) in 10 allergic nasal patients. In normal bathing, VAS scores showed that nasal congestion was alleviated only immediately after normal bathing. AR showed no significant increase in nasal cavity volume was observed. The mist sauna, however, alleviated nasal congestion for more than 30 minutes. Even 90 minutes after having mist sauna, significant alleviation of nasal congestion was still observed, demonstrating its effectiveness over normal bathing. Mist sauna effectiveness is similar to that of local nasal thermotherapy. Having a daily mist sauna is thus considered useful in nasal allergy.

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[in Japanese]

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Environments of nebulizer device use must be made safe, particularly in maintenance based on hospital function evaluation and improvements in awareness in preventing of nosocomial infection.

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Nebulizer therapy has been widely used for nasal and laryngopharyngeal disease.
The nebulizer drug solution contamination is a major concern for which few reports have been made.
We surveyed nebulizer solution contamination, its causes, when they occur whether by inspiration or by the nebulizer, and backflow contamination of the nebulizer solution from the patient.
We focused on one ultrasonic nebulizer and two jet nebulizers.
Our results suggest the following :
1. No bacteria were observed in any drug solution at preparation.
2. No contamination by inspiration or nebulizer was observed in the jet nebulizer drug solution.
3. Contamination by the apparatus was not detected in the ultrasonic nebulizer.
4. No bacteria were detected in external tubes, internal tubes, or and drug solution tanks after patients used the jet nebulizer.
5. No bacteria were detected in external tubes or drug solution tanks after patients used the supersonic nebulizer. Glucose nonfermenting gram-negative rods such as Empedobacter brevis and Alcaligenes xylosoxidans were detected, however, in solution tanks after use by the patient.

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